Abstracts fra Bibliotek for Læger 1/2015

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Originalartikel: Det første kejsersnit i Danmark på levende moder
Torsten Sørensen †

The first caesarean section in Denmark performed on a woman who was alive

Bibl Læger 2015;207:7-14

The operation was performed by the army surgeon Poul Elias Wintmöl Schlegel October 26, 1813. He was sent for by a colleague to a farmer’s house southwest of Hillerød. A woman had been in labour for two days without any progress. The two doctors concluded that delivery by forceps and instruments was the best method to end the labour. But this solution was vigorously rejected by the husband and his wife. They had heard about a method by which the child was cut out of the mother and both child and mother had been saved. So they begged for that operation. The doctors agreed and Schlegel performed the caesarean section and successfully delivered a boy weighing four kilograms. Schlegel writes:”The woman had gone through the operation very well and asked if she might not fortify herself with a glass of aquavit and a cup of coffee, and she became not at all satisfied when this was strongly forbidden”. Two days after the operation she died from intestinal paralysis and infection. The child survived.

 

Originalartikel: Dikt og virkelighet - Fra keisersnittets tidlige historie
Per E. Børdahl

Myth and reality. From the early history of caesarean section.

Bibl Læger 2015;207:15-41

While many other major surgical operations can be traced in historical sources, nobody knows where and when the first caesarean section was performed, much less by whom. This article discusses legal texts, poems and folk songs depicting the operation in antiquity and during the early Middle Ages. At first caesarean section was probably only used post-mortem, mainly for religious reasons. The discussion on caesarean birth became a medical topic with Rousset’s book on caesarean childbirth in 1581, which met with much resistance from contemporary surgeons. Through the next centuries, maternal mortality after a caesarian operation was close to 100 %, and it was not until the last decades of the 19th century, with introduction of aseptic and antiseptic surgery and changes in surgical techniques, that the prospects for Caesarian delivery were substantially improved. These changes are here discussed in connection with contemporary medical textbooks and articles. Clinical results and changing attitudes in Denmark and Norway, as expressed in obstetric textbooks, demonstrate how quickly significant obstetric improvements in continental Europe were introduced in these countries.

 

Et billede fra min hverdag
Jens Langhoff-Roos

 

Originalartikel: Kejsersnit på moders ønske
Hanne B. Wielandt & Ole J. Hartling

Caesarean section on maternal request

Bibl Læger 2015;207:44-58

The increasing number of delivery by caesarean section is much debated, including caesarean section on maternal request. In Denmark it has been calculated that approximately 2.5 % of the deliveries are performed by caesarean section on maternal request. The present paper discusses ethical and legal aspects with a focus on the role of the medical doctor. The medical doctor has beneficence-based and autonomy-based obligations towards the pregnant woman and beneficence-based obligations towards the fetus. Delivery is considered as the natural way to end a pregnancy, and physiologically it is beneficial to mother and child. Hence, there has to be a medical indication for performing caesarean section, and generally it is not the task of the patient to state the indication. This would skew the principle of patient autonomy since patient autonomy is a clear right to refuse any treatment, but not a right to demand any treatment. The medical doctor must consider risks and benefits related to delivery by caesarean section and must focus on communication and antenatal care. Therefore, the implicit balance between beneficence and non-maleficence may well lead to performing a caesarean section without a clear medical indication.

 

Originalartikel: Kejsersnit, kirurgi og evidens
Jeppe Bennekou Schroll

Caesarean section, surgery and evidence

Bibl Læger 2015;207:59-77

Caesarean section is a very common surgical intervention, which imposes us to be certain to conduct it in the best way possible. How should a caesarean section be performed? It has been difficult to prove that two different techniques give different results, probably because different techniques, despite the surgeons’ certainties, have little influence on patient relevant outcomes. The question of when caesarean section should be performed has only been tested in very few indications. Surgical studies are generally of low quality. Few intervention trials are conducted and even fewer blind the patients and outcome assessors, even though it is possible with “sham surgery”. Adverse events of surgery are often uncertain, partly due to poor studies and partly because there is no consensus of what a complication really is. There is evidence of considerable publication bias in surgery, which skewers our perception of benefit. There is a wide variation in which techniques surgeons use, but each surgeon often has great thrust in his or her choice of techniques. This might hinder conductions of trials as surgeons might not acknowledge clinical equipoise. The regulatory agencies have a big part of the responsibility for the variation and lack of evidence in surgery. They require no testing when new procedures are introduced which seems absurd compared to the extensive requirements in drug approval. Sham surgery has spared millions of patients from worthless or harmful treatment but are still debated and infrequently used. We owe our patients well-documented surgery. Regulatory agencies need to increase the standards, for instance by requiring blinded placebo trials.

 

Kvartalets genstand
Morten A. Skydsgaard

 

Klassisk artikel: Beskrivelse af en Section cæsarea, foretaget af Undertegnede i forbindelse med Distriktschirurg Lynge paa en Insidders Kone i Frøersløv Bye ved Frederiksborg den 26de October 1813

Genoptryk af Poul Schlegels beskrivelse af det første kejsersnit udført i Danmark på en levende mor, oprindelig bragt i Bibliotek for Læger 1815.
Poul Elias Wintmöl Schlegel